Mild traumatic brain injury (mTBI) and concussion, a subtype of mTBI, commonly present to the emergency department (ED)and may present with symptoms identical to those associated with more severe TBI. The development and use of clinical decision rules, increased awareness of the risk of radiation associated with head computed tomography, and the potential for patient observation has allowed emergency clinicians to make well-informed decisions regarding the need for imaging for patients who present with mTBI. For patients who present to the ED with concussion, appropriate diagnosis, management, and education are critical for optimal recovery. This issue reviews the most recent literature on concussion and mTBI and provides recommendations for the evaluation, diagnosis, and treatment of mTBI and concussion in the acute setting.
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Following are the most informative references cited in this paper, as determined by the authors.
2. * Lumba-Brown A, Yeates KO, Sarmiento K, et al. Diagnosis and management of mild traumatic brain injury in children: a systematic review. JAMA Pediatr. 2018;172(11):e182847. (Systematic literature review and clinical guideline) DOI: 10.1001/jamapediatrics.2018.2847
3. National Center for Injury Prevention and Control. Report to congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Accessed May 15, 2021. (Literature review and recommendations from the CDC mTBI group)
8. * Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170. (Prospective cohort; 42,412 children) DOI: 10.1016/S0140-6736(09)61558-0
9. * Halstead ME, Walter KD, Moffatt K, et al. Sport-related concussion in children and adolescents. Pediatrics. 2018;142(6). (Guideline) DOI: 10.1542/peds.2018-3074
21. * Committee on Sports-Related Concussions in Youth, Board on Children, Youth, and Families, Institute of Medicine, National Research Council. Sports-related concussions in youth: improving the science, changing the culture. Washington DC: National Academies Press (US). 2014. (Consensus study report) DOI: 10.17226/18377
37. * Osmond MH, Klassen TP, Wells GA, et al. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ. 2010;182(4):341-348. (Prospective cohort; 3866 children) DOI: 10.1503/cmaj.091421
38. * Dunning J, Daly JP, Lomas JP, et al. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child. 2006;91(11):885-891. (Prospective cohort; 22,772 children) DOI: 10.1136/adc.2005.083980
39. * Lyttle MD, Crowe L, Oakley E, et al. Comparing CATCH, CHALICE and PECARN clinical decision rules for paediatric head injuries. Emerg Med J. 2012;29(10):785-794. (Review) DOI: 10.1136/emermed-2011-200225
40. * Easter JS, Bakes K, Dhaliwal J, et al. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Ann Emerg Med. 2014;64(2):145-152, 152.e141-145. (Prospective cohort; 1009 children) DOI: 10.1016/j.annemergmed.2014.01.030
45. * Nigrovic LE, Lee LK, Hoyle J, et al. Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated severe injury mechanisms. Arch Pediatr Adolesc Med. 2012;166(4):356-361. (Secondary analysis of a prospective observational cohort study; 42,412 patients) DOI: 10.1001/archpediatrics.2011.1156
54. * Palchak MJ, Holmes JF, Vance CW, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003;42(4):492-506. (Prospective cohort; 22,772 children) DOI: 10.1067/s0196-0644(03)00425-6
57. * Dayan PS, Holmes JF, Schutzman S, et al. Risk of traumatic brain injuries in children younger than 24 months with isolated scalp hematomas. Ann Emerg Med. 2014;64(2):153-162. (Secondary analysis of a prospective multicenter cohort study; 10,659 children) DOI: 10.1016/j.annemergmed.2014.02.003
92. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Accessed May 15, 2021. (Clinical descriptions and diagnostic guidelines)
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Keywords: mild traumatic brain injury, mTBI, clinically important traumatic brain injury, clinically important TBI, ciTBI, concussion, sports-related concussion, sport-related concussion, symptoms of concussion, clinical decision rules, Pediatric Emergency Care Applied Research Network, PECARN, Canadian Assessment of Tomography for Childhood Head Injury, CATCH, Children’s Head Injury Algorithm for the Prediction of Important Clinical Events, CHALICE, Glasgow Coma Scale, GCS, Pediatric Glasgow Coma Scale, pGCS, Sideline Concussion Assessment Tool, SCAT, SCAT5, Maddocks questions, Balance Error Scoring System, BESS, mBESS, tandem gait evaluation, Standardized Assessment of Concussion, Post–Concussion Symptom Scale, Vestibular Ocular Motor Screening, VOMS, King Devick Test, cognitive assessment, balance assessment, vestibular-ocular assessment, computed tomography, magnetic resonance imaging, neuroimaging, post–concussion syndrome, posttraumatic headache, second-impact syndrome, SIS, ImPACT, sideline assessment, sideline care, evaluation for concussion, nonaccidental trauma, return-to-sports recommendations, return-to-school recommendations
Madeline Joseph, MD, FACEP, FAAP; Audrey Paul, MD, PhD
Susan B. Kirelik, MD, FAAP; Todd W. Lyons, MD, MPH
June 2, 2021
July 1, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits.
Date of Original Release: June 1, 2021. Date of most recent review: May 15, 2021. Termination date: June 1, 2024.
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